This week saw the publication of an important report from the Mental Health Network on The Future of the Mental Health Workforce for which I was pleased to have been involved in co-chairing the Reference Group. The report set out some important ideas for how we can deliver the numbers and type of workforce we need in the next ten years. It came on the back of Stepping Forward to 2020/21, Health Education England’s mental workforce plan, which highlighted clearly and starkly the scale of the challenge (19,000 new members of staff by 2020 and that before we feel the full impact of Brexit) required to deliver the Five Year Forward View commitments and maintain existing services.
We have been pretty remiss over the years in mental health, as elsewhere in the health and care sector, in giving proper attention to workforce issues. They are fundamental, not just to the practical logistics of delivering care, but also to the character and quality of patient experience, most particularly in mental, health where human contact and relationships are at the heart of the therapeutic process. So I am glad to see a greater attention and focus but, just as importantly, a willingness to think differently about the image, shape and approach of the mental health workforce.
The Future of the Mental Health Workforce highlights a number of important themes which I would like to discuss further in this blog.
The first relates to how we promote careers in mental health to young people. As attitudes towards mental health change and with mental health being so prominent as an issue in the lives of young people there will be a great chance of engaging young people about what a career in mental health might have to offer. This is not something we have ever done in any systematic way but there is a big opportunity to do so now, starting in schools but also in attracting those who have already enter clinical professions to specialise in metal health – the Royal College of Psychiatrists “Choose Psychiatry” campaign is a great example.
In doing so we need to portray an inspiring but also realistic vision of working in mental health. A serious point of concern, at present, is the rate of drop out of new trainees, insufficiently well prepared for and supported to face the pressures of some of the more challenging aspects of mental health work. Good quality supervision and mentoring are not a luxury and must be recognised by providers and commissioners as part of service specifications.
Some of the requirements for new staff will come through the creation of new roles such as physician and nurse associates and by the expansion of roles for peer workers, one of the most positive developments in mental health care in the last decade. Similarly, some of the issues can be addressed by getting existing staff to take on new extended roles, for instance the training of psychologists to take on roles as responsible clinicians.
New roles are not a panacea however. To work they need new thinking about service models and the role which more experienced clinicians play in supervising and supporting less experienced staff. They also crucially need new thinking about careers. As the history of IAPT indicates, we can be successful in attracting new entrants to the workforce but we will also need to think how such staff can progress to other roles in mental health or else we run the risk of losing them.
The theme of career pathways is a further important theme. There is, at present, a striking imbalance across the mental workforce. With 100,000 students registered on psychology courses, we have enormous interest in psychology as a profession while at the same time we have significant shortages in other professions such as nursing and psychiatry. The report, rightly, did not question the importance traditional professional disciplines but highlighted the opportunity in mental health to create much more flexible career paths across professional boundaries and the valuing of core competencies which are relevant in most areas of mental health work.
The issues around careers also apply to older staff. One of the largest challenges for the mental health workforce has been the impact of mental health officer status, a convenient solution to recruitment challenges 30 odd years ago of which we are now seeing the consequences with large numbers of staff taking advantage of the opportunity to retire at the age of 55. As I know from my own organisation is not inevitable that staff near the age of retirement want to leave mental health for good. Many feel an enormous sense of commitment to the work they do and the patients they serve. However, we are naïve if we expect staff just to carry on with some of the stressful and pressured roles they currently occupy. Even if staff do not want to carry on with existing clinical work there are roles around supervision, mentoring and teaching through which they can use their experience to the benefit of the wider workforce. There may be also roles in the voluntary sector for instance, which offer different opportunities for older staff. The support and development opportunities we provide for staff in the last third of their careers in considering these choices are crucial.
The last theme of the report and one which resonates with other blogs I have written recently is the need to address and invest in staff wellbeing and resilience. This needs to be honest about the distressing nature of mental health work and the specific stresses of the current environment. There are many approaches: Schwartz Rounds, Balint Groups, Work Discussion Groups which can give staff the opportunity to reflect on their experiences. If we are to have any chance of avoiding burnout and improving retention their implementation should be a mainstream part of an organisational commitment to promoting wellbeing.
It’s encouraging to see workforce more centre stage in debates about NHS priorities although we need to be sanguine about the scale of challenges facing us in mental health. There are things we can do to turn round the position and we need to be willing to invest where that is necessary to make them happen. At the end of the day, a career in mental health is, at its best, one of the most meaningful and satisfying things you can do.
Republished courtesy of Paul Jenkins. Originally published on 23 September 2017
Paul Jenkins is CEO of The Tavistock & Portman NHS Foundation Trust, and SRO for our Mental Health workstream.